Healthcare Provider Details

I. General information

NPI: 1316212889
Provider Name (Legal Business Name): LISA RUTH HIMMELSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2012
Last Update Date: 03/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 LONDONDERRY RD
ALEXANDRIA VA
22308-2332
US

IV. Provider business mailing address

2515 LONDONDERRY RD
ALEXANDRIA VA
22308-2332
US

V. Phone/Fax

Practice location:
  • Phone: 703-799-2587
  • Fax:
Mailing address:
  • Phone: 703-799-2587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101043256
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: